Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Monday, February 25, 2013

Too obvious to study?

Yes, but sometimes you need to prove the obvious before anybody will do anything about it. Believe it or not, some U.S. medical schools still don't have policies to stop drug companies from brainwashing their students. They do this by sponsoring talks in which a corrupt physician or company flack pitches their products, often accompanied by free lunch; and by handing out gifts, including not only tschochkes but also school supplies and devices of significant value. Since the American Medical Student Association, to its credit, is against these practices, and has started grading medical schools on their policies restricting marketing to students.

In the new BMJ, King et al look at the results. It turns out that for 2 of the 3 drugs they studies, graduates of medical schools that had policies restricting drug company marketing to their students were less likely to prescribe these drugs after they completed their residencies. The drugs were new, brand name drugs that weren't any better than older, cheaper generics. It's not clear why there wasn't an effect with the third one, desvenlaxafine, which by the way has not been approved for use in Europe and for which very weak evidence of efficacy exists. The authors say this appeared to be due to fairly high prescribing by the early cohort in the group less exposed to marketing as medical students, which suggests it may have been other marketing efforts that obscured the effect. Anyway . . .

There is no excuse whatsoever for any medical school to allow drug companies anywhere near its students, in any way. Drug company representatives and drug company sponsored talks or other events should be totally banned. 100% of the education medical students get about pharmaceuticals and prescribing should be provided by people with no financial interest of any kind in anything they will do once they enter practice.